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Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic

Black, JA, Campbell, JA ORCID: 0000-0002-1820-6758, Parker, SC, Sharman, JE ORCID: 0000-0003-2792-0811, Nelson, MR ORCID: 0000-0001-9941-7161, Otahal, P ORCID: 0000-0003-4042-1769, Hamilton, G and Marwick, TH ORCID: 0000-0001-9065-0899 2021 , 'Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic' , Medical Journal of Australia , doi: 10.5694/mja2.50960.

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Abstract

Objectives: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.Design: Prospective, randomised, open label, blinded endpoint study.Setting: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.Participants: Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥ 8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded.Main outcome measures: The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events.Results: The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group.Conclusions: An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores.

Item Type: Article
Authors/Creators:Black, JA and Campbell, JA and Parker, SC and Sharman, JE and Nelson, MR and Otahal, P and Hamilton, G and Marwick, TH
Keywords: cardiology, rapid access chest pain clinic, quality of life
Journal or Publication Title: Medical Journal of Australia
Publisher: Australasian Med Publ Co Ltd
ISSN: 0025-729X
DOI / ID Number: 10.5694/mja2.50960
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Copyright 2021 AMPCo Pty Ltd

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